There is evidence of an ongoing gap in healthcare outcomes in the Aboriginal and Torres Strait Islander peoples in Australia as compared with those from non-Aboriginal backgrounds.(1) Since the establishment of the ‘Closing the Gap’ initiative in 2006 minimal progress has been made in decreasing the 10 year discrepancy in life expectancy and poorer chronic disease outcomes in Aboriginal vs non-Aboriginal populations.(2) Further, the main focus of this report is on infectious and lifestyle diseases and there is minimal literature available on less common diseases. Nevertheless, in rheumatology there is evidence internationally that the manifestations of diseases such as lupus vary according to ethnicity, and are both overrepresented in Indigenous populations and associated with poorer outcomes. (3, 4, 5)
The higher disease morbidity and mortality in Aboriginal and Torres Strait Islander peoples is associated in part with unsuccessful healthcare delivery.(2, 6) Rheumatology patients are afflicted by chronic diseases which pose a particular challenge for care in view of the fatigue associated with the need for ongoing treatment and risk of relapse or progression.(7) Engagement with healthcare providers in the long term is thus essential to achieving positive disease outcomes. Practitioners therefore require a better understanding of the cultural elements which may preclude engagement with existing health systems such as the historical distrust of health providers, literacy levels, traditional remedies, health beliefs and the need to attend cultural events.(8, 9)
The only way to build this dialogue is through collaborative research. The deficit of research involving the Indigenous Australian population has led to difficulties with getting positive outcomes from health policy and planning.(6) There has been a historical lack of cultural sensitivity and competence in the development of health research, especially with regard to the social determinants of health such as education, employment, housing, history of dispossession, interruption of culture, intergenerational trauma and racism.(6, 4, 9) It is in this context that a literature search was undertaken to define what evidence exists on the incidence and pattern of rheumatologic disease in the Indigenous Australian population, and to identify where the gaps exist. Specifically, investigating where research has been undertaken, what proportion of research is authored by First Nations people and what barriers have been discussed in collating data on this population. This with a view to understanding the limitations of current published literature and providing a roadmap to building a stronger, culturally safe knowledge base in the area. This literature review will be used to inform a qualitative project on the Indigenous perspectives around attending Rheumatology clinic.